11272 jobs found

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Perform complex retrospective and prepayment reviews of medical records to identify potential abuse and fraud and inappropriate billing practices. Responsible for second level appeals reviews Investigate, analyze, and identify provider billing patterns to recommend payment based on medical records, claim history, billing codes, regulatory and state guidelines, and policies Prepare summary of findings and recommend next steps for providers Identify preventative measures and recommend changes to internal policies and procedures and/or provider practices to prevent future  fraudulent and erroneous practices   Consult investigators to identify abuse and fraud by utilizing clinical and coding...

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. • Maintain updated documentation regarding how the team processes, adjustments to current schedules, and implement changes to those processes to maintain best practices based on business needs • Identify workflow process trends, analyze contributing factors, and make recommendations for improvements • Work with trainers to ensure smooth processes of scheduling trainings to adhere to training schedules • Monitor adherence and identify unexpected staffing gaps due to absences, and  report trends and suggestions to improve • Analyze real-time reports in various workforce management systems ensure the entire direct call center achieves service level by interval • Suggest to call center...

You could be the one who changes everything for our 26 million members as an Intern at Centene. During this 12-week program, you'll learn more about Centene and how we're transforming the health of the community, one person at a time.  Position Purpose: Observe preceptors and participate in various projects to learn and develop skills related to the Managed Care industry. Education/Experience: Current enrollment in an accredited clinical program. Candidates must be receiving course credit for participating in the Externship program. Develop clinical knowledge and skills by learning about various processes and functions within the Managed Care industry    Observe processes and shadow preceptors to gain hands on experience and become familiar with various clinical services Follow instructions and procedures provided by preceptor or manager in accordance with company guidelines Centene is an equal opportunity employer that is committed to diversity, and values the...

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: The Credentialing Specialist II implements and monitors procedures, activities and/or projects related to credentialing, re-credentialing and privileging of network providers. Processes provider applications and re-applications including initial mailing, review and loading. Maintains provider profiling system and communication with providers by phone and mail regarding credentialing status and information. Provides guidance to less experienced specialists. May provide workflow direction for other specialists in the department. • Analyzes all information sent in by the physician/provider and received through Federal and State queries, and compares it to established criteria....

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. THIS POSITION IS REMOTE/WORK FROM HOME IN NORTHUMBERLAND COUNTY, PA. IT WILL TRAVEL APPROX. 50% OF THE TIME TO VISIT PARTICIPANTS WITH MILEAGE REIMBURSEMENT AT THE IRS GUIDELINE RATE. Position Purpose: Responsible for assisting participants with gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, person centered care plan development, assessment, and service coordination. Complete assessments with participants, caregivers, natural and community supports, or providers to obtain information regarding client status, support system, and need for services for person centered care plan development Monitor delivery...

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Conduct training related to Claims. Develop, design and implement training curriculum and implement new products. • Train, inspire, motivate, and coach employees to obtain desired quality and production results • Identify and develop appropriate training programs, including the selection or design of appropriate training aids • Communicate training progress to management during and after training in a qualitative and efficient manner • Create, prepare and update class paperwork and training aids • Demonstrate effective presentation skills and excellent customer service skills • Conduct training needs analyses • Perform audits to determine training needs. Recommend policies...

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Remote Available Position Purpose: Analyze integrated and extensive datasets to extract value, which directly impacts and influences business decisions. Work collaboratively with key business stakeholders to identify areas of value, develop solutions, and deliver insights to reduce overall cost of care for members and improve their clinical outcomes. Interpret and analyze data from multiple sources including healthcare provider, member/patient, and third-party data. Support execution of large-scale projects with limited direction from leadership Identify and perform root-cause analysis of data irregularities and present findings and proposed solutions to leadership and/or customer Manage...

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Support the product team’s focus on offering quality, competitive product solutions for growth and retention of our marketplace members. Lead the annual Product Development Life Cycle for the Commercial Marketplace products in all states, working as part of a cross-functional effort to deliver on business objectives. Manage a staff who are responsible for the completion of product design, competitive intelligence, pricing and demographic analysis of our customers and products. ·         Deliver predictable, sustainable and profitable growth for commercial products. ·         Develop and deliver multi-year product roadmap(s), lead strategic planning, develops initiatives...

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function *Applicants for this job have the flexibility to work remote from home and must reside in MO, FL, MI* • Support business initiatives through data analysis, identification of  implementation barriers and user acceptance testing of various systems • Identify and analyze user requirements, procedures, and problems to improve existing processes • Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations • Identify ways to enhance performance management and operational reports related to new business...

You could be the one who changes everything for our 26 million members by using technology to improve health outcomes around the world.  As a diversified, national organization, Centene's technology professionals have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Design, build, test and maintain scalable and stable off the shelf application or custom built technology solutions to meet business needs • Contribute to the entire implementation process for new applications and enhancements to existing applications • Meet with business partners to understand business needs • Contribute to overall solution design • Responsible for build and test of applications • Conduct root cause analysis and complex performance tuning Education/Experience: Bachelor's degree in Computer Science, MIS, related field or equivalent experience. 2+ years of related experience. Healthcare experience a plus. Experience with SQL. Working...

About the Job The Senior People Business Partner (SPBP) is responsible for providing consultation and support to managers and staff in all areas of Human Resources. The PBP oversees the delivery of annual HR processes and programs in close collaboration with People Strategy Leaders (PSLs) and People Team Centers of Expertise (COEs). The PBP also provides day-to-day guidance and support to employees and managers with assigned business units and participates in and/or leads business unit specific projects as needed. Key Responsibilities Build strong relationships and partnerships within the People Team and with managers and employees across the business. Consult with and advise managers on and decisions related to annual people processes, leveraging best practices and organizational guidance. Support managers with interpretation and application of employee policies & practices. Act as point of contact for employee relations issues. Practice sound...

About the Job The Director, Business Strategy, Commercial Operations supports profitability and operational excellence across of the commercial organization; develop impact strategies and measurement for operational effectiveness for the Commercial teams. This role is heavily involved in the periodic management of business flow including strategic initiatives related to field-based adoption of programs to maximize test throughput to revenue. The position supports the Commercial Leadership Team on assessment and program management of key strategic initiatives for Telehealth, collaboration to leverage 3rd party services to streamline operations and evangelism of new methodologies cross field teams. Key Responsibilities Collaborate across the commercial group to support business reports with long range plans and related strategic initiatives. Assess current operations to refine the overall business processes and strategy in partnership with Commercial insights...

About the Job The Clinical Genomics Scientist, Medical Affairs sits on the Medical Affairs Team as a scientific communicator supporting educational outreach activities and scientific endeavors of the team. These include, but are not limited to, participation in Molecular Tumor Boards, Peer-to-Peer Advice and support of publications and collaborations with other departments (Marketing, Legal, Regulatory and Sales) across the company. This role analyzes and interprets genomic alterations and discusses clinical insights from FMI’s test reports with external medical teams. The incumbent is a subject matter expert in cancer genomics broadly, as well as in analysis and interpretation of genomic findings resulting from FMI testing, scientific oversight of marketing collateral, and other high-impact initiatives. Key Responsibilities Prepare, research, summarize, and discuss genomic findings for chosen clinical cases during Molecular Tumor Boards (MTBs) with internal team....

Job Description: Role Summary/Purpose: In this role you will be responsible for supporting the enhancement of key access management and data security controls across to ensure sustainability in our on-premises technology environment, while driving maturity in anticipation of migrating to public cloud . This is a hands-on role encompassing control design , oversight and enforcement of control adoption , and ongoing monitoring for assessment of effectiveness and resulting risk mitigation . As a Technology & Operations Control Lead you will have engagement with leaders to formalize our 1LOD approach to enhance our control coverage to help Synchrony more effectively mitigate identified risks . You will partner with relevant governance and control functions, including Information Security, Chief Data Office, Public Cloud program team, Compliance , and Risk Management to ensure appropriate controls are embedded into the development, assurance, and production validation...

Job Description: Role Summary/Purpose: The AVP, IT Credit Initiatives Scrum Master will be responsible for leading multiple agile scrum teams executing on development for Strategic Initiatives within the Credit organization, PRISM ARTs , and PRISM Large Solution. They will foster agile behavior and be a servant leader and coach to their team/s. They will assist their self-organizing teams in achieving their goals/commitments by facilitating discussions/meetings, collaborating across the company, removing roadblocks, maintain the teams focus, and foster continuous delivery/improvements. We're proud to offer you choice and flexibility. You have the option to be remote, and work from home, or come into one of our offices. You may be occasionally requested to commute to our nearest office for in person engagement activities such as team meetings, training and culture events. Essential Responsibilities: Support SAFe Core Values, apply SAFe Principles, & implement/follow...

Job Description: Role Summary/Purpose: The Identity & Access Management (IAM) Program Manager will be responsible for driving multiple high visibility, cross-functional projects, working with the Identity and Access Management organization, broader information technology and security teams to manage IAM strategic programs and regulatory findings. This exciting role requires critical thinking skills, building key relationships, leadership skills and behaviors to drive transformation of Identity and Access Management. This position is remote, where you have the option to work from home. On occasion we may request for you to commute to our nearest office for in person engagement activities such as team meetings, training and culture events. To ensure the safety of our colleagues and communities, we require employees who come together in-person to be fully vaccinated. We're proud to offer you choice and flexibility. We're proud to offer you choice and flexibility. You have...

Job Description: Job Description: The Sr. P2P/T&E Specialist role will be accountable for P2P supplier onboarding and record maintenance, review and analysis of purchasing requisitions and to provide T&E corporate card holder assistance. This role will ensure that team targets and key performance indicators are met and/or exceeded, and will support operational excellence and continuous improvement initiatives. Essential Responsibilities: Partner with suppliers and Synchrony Supplier Managers to advise and enhance new supplier on-boarding and change process through Coupa Supplier Portal Utilize Coupa, Oracle and 3rd Party validation tools to evaluate and analyze supplier registration approvals Review, manage and approve Coupa supplier record change requests Monitor API feed to ensure new supplier and supplier change information flows accurately from Coupa to Oracle Manage setup and ongoing maintenance of new and existing supplier sites for PO and/or...

Job Description: Role Summary/Purpose : As the General Manager of the Verizon program, this role is responsible for leading and managing all aspects of the client relationship and portfolio performance. The role of the General Manager is to effectively own the client relationship, navigate the client organization at all levels and serve as the primary liaison between Synchrony and Verizon - in addition to driving growth and profitability of the Verizon portfolio by increasing assets/accounts, identifying and executing profitable growth initiatives, introducing additional products, leading SYF's cross-functional team and enhancing the client relationship in order to win support for growth initiatives We're proud to offer you choice and flexibility. You have the option to be remote, and work from home, or come into one of our offices. You may be occasionally requested to commute to our nearest office for in person engagement activities such as team meetings, training and...

Job Description: SVP, Health & Wellness Client Marketing Leader: Dental, Veterinary, B2B Lifecycle Role Summary/Purpose: This role will lead B2B and B2B2C marketing for the Dental and Veterinary industries plus the Provider lifecycle marketing across the CareCredit network. This role will initiate strategies to build awareness, drive client/practice enrollment, new account growth and usage among large, mid-market and smaller client practices. We're proud to offer you choice and flexibility. You have the option to be remote, and work from home, or come into one of our offices. You may be occasionally requested to commute to our nearest office for in person engagement activities such as team meetings, training and culture events. Essential Responsibilities: Lead CareCredit's Dental and Veterinary provider marketing teams to develop and implement strategies and programs to achieve industry network enrollment, activation, usage and retention goals. Engage with...

Job Description: Role Summary/Purpose As a key member of the B2B Digital Products Team, this leadership role is responsible for helping drive and achieve Synchrony's business objectives focusing on the Commercial credit products. The Digital Program Manager will be responsible for leading a set of Agile teams that deliver new features, capabilities and enhanced B2B experiences. The preferred candidate will demonstrate SYF's ability to understand and meet our client's and customer's needs through technology-driven and innovative solutions in partnership with Technology, Credit and other Synchrony teams. This leader will need to be a strategist, executor, and strong communicator to help identify opportunities for product expansion and enhancement that enables business growth. This position is remote, where you have the option to work from home. On occasion we may request for you to commute to our nearest office for in person engagement activities such as team meetings, training...